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07020065 CITE'OF CUPERTINO BUiLDIN(,DIVISION PERMITS � � RMTIIJN. BUILQj1yG69DjtESWHPERMIT NO. EATON DR GENMOR PLUMBING 07020065 OWNER'S NAME: PERMIT ISSUE DATE KAREN HUSHER 3560 HAIG ST. #2 02/12/2007 JNE: SANITARY NO. CONTROL NO. (408) 855-8348 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH o p LICENSED CONTRACTOR'S DECLARATION Job Description U P I hereby affirm that I am licensed under provisions of Chapter 9(commencing ;zw with Section 70(X))ofDivision 3 of the Business and Professions Code,and my license is COPPER REPIPE & 1 MAIN WATER SERVICE ? ti in full force and effect - t ? License Class Lic.8 rp Dae —13 Contractor 17 e\ ARCHITECTS DELLA AT10N i a I understand my plans shall be used as public records )yU U.y Licensed Professional y OWNER-BUILDER DECLARATION i hereby affirm that I am exempt from the Contractor's License Law for the 00 following reason.(Section 7031.5,Business and Professions Code:Any city or county e which requires a permit to construct,alter,improve,dcmolLsh,or repair any structure Z y prior to its issuance,also requires the applicant for such permit to file a signed statement =G that he is licensed pursuant to the provisions of the Contractor's License law(Chapter 9 Sq.Ft.Floor Area Valuation at— (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $6500 y that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of Number Occupancy Type not more than five hundred dollars(5500)_ 31623 084 ❑I,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the struaum is notintended or offered forsale(Sec.7044,Business Required Inspections and Professions Code:The Contractor's License Law does not apply to an owner of q P property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for sale.If, however,the building or improvement is sold within one year of completion,the owner. builder will have the burden of proving that he did not build or improve for purpose of sale.). ❑I,as owner of the property.am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li- cense Law does not apply to an owner of property who builds or improves thereon,and who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law. ❑i am exempt under Sec. B&P C for this mason OwnerLADate WORKER'S COMPENSATION DECRATION 1 hereby affirm under penalty of perjury one of the following declarations: ❑1 have and will maintain a Certificate of Consent to self-insure for Worker's Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Ca I have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this Permit is issued. My Wor s Compens tion Insurance carrier and Policy be ^ Carrier. — r Policy No.:J.�LL JSJ CERTIFICATE OF EXEMPTION FROM WORKS S' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) or less) I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California.Dae Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must ,J O forthwith comply with such provisions or this permit shall be deemed revoked. Z" CONSTRUCTION LENDING AGENCY [-� i hereby affirm that there is a construction lending agency for the performance of > the work for which this permit is issued(Sec.3097,Civ.C.) aQ Lender's Name z Lender's Address U 0 1 certify that i have read this application and state that the above information is Lt,►r correct-I agree to comply with all city and county ordinances and state laws relating to O V building construction,and hereby authorize representatives of this city to enter upon the Uahove-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against f/j liabilities,judgments,costs and expenses which may in any way accrue against said City U Z in consequence of the granting of this permit. Date r" APPLICANT UNDERSTANDS AND WILL COMPLY WiTH ALL NON-POINT Issued by. SOURCE REGULATI S. Re-roofs Signature of Applicanl/Contrac Date HAZARDOUS MATERIALS DISCLOSURE Type of F oof Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Ycs [}No If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new R aterials for inspection. District? ❑Yes in No 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Cade,Sections 25505,25533 and 25534.1 understand that if the building docs not currently have a tenant,that it is my responsibility to notify the occupant or the requirements which must be t prior to issuance of a Certificate of Occupancy. Signature of Applicant Date " All roof coverings to be Class "B"or better Owner or authorircd agent Date bW Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 CUPEkTINO Building Department JOB ADDRESSZ � PERMIT�# r7Q=r--,, - OWNER'S NAME: v PHONE � GENERAL CONTRACTOR: l FAX # I am not using any subcontractors,-• Y — ' i gnature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSI14ESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass/ Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date CITY OF CUPERTINO 3 ITEMS OF 8 PERMIT RECEIPT OPERATOR: amyw COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . . 31623084 . 00 DATE ISSUED. . . . . . . : 02/12/2007 RECEIPT #. . . . . . . . . : BS000000440 REFERENCE ID # . . . : 07020065 SITE ADDRESS . . . . . : 20084 WHEATON DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . . KAREN HUSHER ADDRESS . . . . . . . . . . . CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2340 RECEIVED FROM . . . . : RECEIPT INTERFACE CONTRACTOR . . . . . . . : GENARO MORALS LIC # 27101 COMPANY . . . . . . . . . . : GENMOR PLUMBING ADDRESS . . . . . . . . . . . 3560 HAIG ST. #2 CITY/STATE/ZIP . . . : SAMTA CLARA, CA 95054 TELEPHONE . . . . . . . . : (408) 855-8348 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BPERMFEE VALUATION 7, 000. 00 137 .16 0. 00 137 .16 0. 00 BPWSVCS WATER SERVICE 1 . 00 9 . 00 0. 00 9 . 00 0. 00 PPERMITFEE FLAT RATE 1. 00 38 .37 0. 00 38.37 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 184 .53 0. 00 184 .53 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 444 . 08 3726 --------------- TOTAL RECEIPT 444 . 08 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 301 ROUGH PLUMBING 502 FINAL PLUMBING ENERGY 507 FINAL PLUMBING CITY OF CUPERTINO REPIPE/SERV PS/MAIN SERVICE CUPEkTINO PERMIT APPLICATION FORM APN # 3 ,t ^ �2 Date: - LY � `d Building Address: 0 e wr0 \ C � Owner's Name: Phone#- NL 0,y e rCtr,act se or: hone: _ Licen #: - 6 C�M-\ : Phone: Cupertino usiness License#: �rRE&&-A2� - Building Permit Info: Bldg ❑ Elect ❑ Plumb 9- Job Description: Residential Commercial ❑ Cost of Project. r-� 0 e� Lk Qty. if Applicable Fee ID Fee Description Fee Group BPERMFEE Bldg. Permit Fees BUILDING BPGAS Gras Piping System Fee PLUMBING PPERMITFEE F lumbing Permit Issuance PLUMBING BPREPIPE F.epi e of Fixtures PLUMBING BPFIXTURE Fblg. Fixture PLUMBING BPWSVCS slain Water Service PLUMBING BPSEWER S ewers PLUMBING BPSEWAGE Sewage Disposal PLUMBING BUSLIC E usiness License BUILDING